MANAGEMENT OF HEMORRHAGE IN LAPAROSCOPIC COLORECTAL SURGERY

Abstract

Abstract Introduction Laparoscopic colorectal surgery (LCRS) offers similar oncologic outcomes to the open approach along with early postoperative recovery but is not without complications, with bleeding being uncommon but with variable impact and technical resource demand. Methods A descriptive and retrospective study of bleeding in patients undergoing elective LCRS in our center between 01/012018 and 31/12/2021. The data analysis was performed using the SPSS statistical software. Results Out of 945 LCRS, 45 patients (4.8%) presented some hemorrhagic event. The main diagnosis was colorectal cancer (35), followed by diverticular disease (6). The procedures most frequently associated with bleeding were sigmoidectomy (13), TATME (7) and right hemicolectomy (7). Five patients presented moderate (4) or severe (1) intraoperative bleeding, controlled during surgery. The most commonly used hemostatic devices were biopolar energy (29.5%) and combined (34.1%). The diagnosis of postoperative bleeding was clinical in 20 cases (45.5%), 17 by CT angiography (38.6%) and 7 by endoscopy (15.9%). In 36.4% the origin of hemorrhage was in the anastomosis, demonstrated by endoscopy or radiological study. Eleven patients (25%) required reintervention: seven by open approach and four by laparoscopy (two conversions). Therapeutic endoscopy was performed in 7 patients (15.9%), in 1 patient interventional radiology-surgery was combined, and in another patient endoscopy-surgery. There was no mortality due to this cause. The mean length of stay after surgery was 19.52 days. Conclusions Hemorrhage in LCRS is a rare but potentially serious complication that requires early diagnosis and staged multidisciplinary approaches, including advanced therapeutic endoscopy and interventional radiology procedures.